Pump thrombosis represents a significant cause of morbidity and mortality in patients on continuous flow ventricular assist devices (CF-VAD). Pump thrombosis in the pediatric CF-VAD population has been reported between 11% and 44%, with the largest reported series from the PediMACS registry reporting a rate of approximately 15%. We report our early experience with four pediatric patients who developed pump thrombosis on a CF-VAD. Our limited experience suggests that the treatment of pediatric VAD thrombosis can be approached with similar principles to the adult population. Our current strategy includes:
i. Initiating treatment with bivalirudin for an isolated rise in LDH with no corresponding rapid rise in plasma-free hemoglobin which may prevent further progression.
ii. Treatment with a low-dose systemic tissue plasminogen activator (TPA) protocol as opposed to targeted therapy via catheter intervention if bivalirudin fails.
iii. If there are concerns with respect to the impact of hemolysis on kidney function or the patient is close to a previous surgery, device exchange can be considered.
The balance between achieving appropriate anticoagulation/antiplatelet therapy in the face of bleeding/hemorrhagic complications remains a challenge. There is a need for larger studies in the pediatric population to outline an algorithm for the definitive management of VAD thrombosis.
From the *Division of Pediatric Cardiology, Stollery Children’s Hospital, Mazankowski Alberta Heart Institute, Edmonton, Alberta; †Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; ‡Division of Pediatric Hematology, Stollery Children’s Hospital, Edmonton, Alberta; and §Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Alberta.
Submitted for consideration August 2016; accepted for publication in revised form February 2017.
This research has been facilitated by the Women and Children’s Health Research Institute through the generous support of the Stollery Children’s Hospital Foundation.
Disclosure: Holger Buchholz was a consultant for Abbott. Jennifer Conway was supported by a research grant from HeartWare Inc. The other authors have no conflicts of interest to report.
Correspondence: Jennifer Conway, Division of Pediatric Cardiology, Stollery Children’s Hospital Mazankowski Alberta Heart Institute 8440 112 St NW, WMC 4C2.29, Edmonton, AB T6G 2C8. Email: email@example.com.